Dialysis-Related Disorders
Problems that can arise in people on dialysis
Quick Facts
- Type: Complications of kidney failure treatment
- Types of dialysis: Hemodialysis and peritoneal dialysis
- Common issues: Low blood pressure, cramps, access infection
- Underlying cause: Kidney failure
Overview
Dialysis is a treatment that does some of the work of failed kidneys by removing waste products and extra fluid from the blood. It is used for people with kidney failure, whether from advanced chronic kidney disease or severe acute kidney injury. The two main forms are hemodialysis, which filters blood through a machine, and peritoneal dialysis, which uses the lining of the abdomen.
Dialysis can be life-sustaining, but it is not a perfect substitute for healthy kidneys, and a range of disorders can arise from the treatment itself and from the underlying kidney failure. Some problems happen during or just after a session, while others develop over months and years. Many can be reduced through careful management of fluid, minerals, blood pressure, and the dialysis access.
Common Problems and Symptoms
Dialysis-related disorders span short-term and long-term issues:
- During or after a session: A drop in blood pressure with dizziness or fainting, muscle cramps, nausea, headache, and fatigue
- Access problems: Infection, clotting, or narrowing of the fistula, graft, or catheter
- Fluid issues: Swelling and breathlessness from too much fluid, or cramps and low pressure from removing too much
- Mineral and bone disease: Imbalances of phosphate, calcium, and potassium that affect bones and the heart over time
- Anemia: Tiredness and pallor from reduced red blood cell production
- Heart strain: A higher risk of heart disease over the long term
Causes
These disorders come from the combination of kidney failure and the demands of dialysis:
- Fluid shifts: Removing fluid during a session can lower blood pressure and trigger cramps if too much is taken off too fast.
- Mineral changes: Failing kidneys cannot balance potassium, phosphate, and calcium, and dialysis only partly corrects this between sessions.
- Access issues: The fistula, graft, or catheter needed for hemodialysis can become infected or blocked.
- Loss of kidney functions: The kidneys also make hormones for red blood cells and bone health, so their failure causes anemia and bone disease.
For peritoneal dialysis, infection of the abdominal lining (peritonitis) is a specific and important complication.
Risk Factors
- Removing large amounts of fluid each session
- Heart disease or diabetes
- Poor blood pressure control
- A dialysis catheter rather than a fistula (higher infection risk)
- Difficulty following fluid, diet, or medication advice
- Older age and frailty
Monitoring and Diagnosis
Dialysis-related disorders are tracked through ongoing monitoring by the kidney care team:
- Blood tests: Potassium, phosphate, calcium, and markers of anemia and dialysis adequacy.
- Weight and blood pressure: Checked before and after sessions to guide fluid removal.
- Access checks: Examining the fistula, graft, or catheter for signs of infection or blockage.
- Heart and bone assessment: Over time, to detect long-term complications.
Management
Management aims to prevent complications and treat them promptly when they occur:
- Blood pressure and fluid: Adjusting how much fluid is removed and the target dry weight; managing fluid intake between sessions.
- Cramps: Slowing fluid removal and adjusting the dialysis settings.
- Mineral and bone disease: Phosphate binders, vitamin D, and dietary changes to protect bones and the heart.
- Anemia: Iron and medicines that stimulate red blood cell production.
- Access care: Antibiotics for infection, and procedures to clear clots or narrowing; replacing a problem catheter.
- Peritonitis: Prompt antibiotics for peritoneal dialysis patients with cloudy fluid or abdominal pain.
Prevention
- Follow fluid and diet advice, including limits on potassium, phosphate, salt, and fluids
- Keep dialysis appointments and complete full sessions
- Care for the access site carefully and watch for signs of infection
- Take phosphate binders and other prescribed medicines as directed
- Report symptoms during or after sessions to the dialysis team
- Keep blood pressure and diabetes well controlled
When to Seek Help
Contact the dialysis team promptly for swelling, breathlessness, persistent cramps, or problems at the access site. Seek emergency care right away for:
- Severe shortness of breath or chest pain
- Fever, chills, or redness and pus at the access or catheter site
- Fainting or severe dizziness
- A racing or irregular heartbeat or severe weakness (possible high potassium)
- For peritoneal dialysis, cloudy fluid with abdominal pain and fever (possible peritonitis)
High potassium and access infections can become life-threatening quickly and need urgent attention.
Frequently Asked Questions
What are the most common problems during dialysis?
The most common problems during a hemodialysis session are a drop in blood pressure with dizziness, muscle cramps, nausea, headache, and fatigue, often from removing fluid too quickly. Adjusting fluid removal and dialysis settings usually helps.
Why do dialysis patients get bone problems?
Failing kidneys cannot balance phosphate and calcium or activate vitamin D, which weakens bones and can affect the heart and blood vessels. Phosphate binders, vitamin D, and dietary changes help manage this mineral and bone disease.
What is the biggest risk with a dialysis access?
Infection and clotting are the main access risks. Catheters carry a higher infection risk than a fistula. Fever, or redness, pain, and pus at the site, need urgent attention, as access infections can spread to the bloodstream.
Why is high potassium dangerous on dialysis?
Between sessions, potassium can build up because the kidneys cannot remove it. Very high potassium can cause a dangerous irregular heartbeat. Following potassium limits and not missing sessions helps; severe weakness or palpitations need emergency care.
What is peritonitis in peritoneal dialysis?
Peritonitis is infection of the abdominal lining used for peritoneal dialysis. Signs include cloudy dialysis fluid, abdominal pain, and fever. It needs prompt antibiotics, so these symptoms should be reported to the dialysis team right away.
References
- National Kidney Foundation. Dialysis.
- MedlinePlus, U.S. National Library of Medicine. Dialysis.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Kidney failure and dialysis.
- Mayo Clinic. Hemodialysis.